Predictors and dynamic online nomogram for postoperative delayed hyponatremia after endoscopic transsphenoidal surgery for pituitary adenomas:a single-center,retrospective,observational cohort study with external validation

Background Postoperative delayed hyponatremia(PDH)is a major cause of readmission after endoscopic transsphenoidal surgery(eTSS)for pituitary adenomas(PAs).However,the risk factors associated with PDH have not been well established,and the development of a dynamic online nomogram for predicting PDH is yet to be realized.We aimed to investigate the predictive factors for PDH and construct a dynamic online nomogram to aid in its prediction.Methods We analyzed the data of 226 consecutive patients who underwent eTSS for PAs at the Department of Neurosurgery in Jinling Hospital between January 2018 and October 2020.An additional 97 external patients were included for external validation.PDH was defined as a serum sodium level below 137 mmol/L,occurring on the third postoperative day(POD)or later.Results Hyponatremia on POD 1-2(OR=2.64,P=0.033),prothrombin time(PT)(OR=1.78,P=0.008),and percentage of monocytes(OR=1.22,P=0.047)were identified as predictive factors for PDH via multivariable logistic regression analysis.Based on these predictors,a nomogram was constructed with great discrimination in internal validation(adjusted AUC:0.613-0.688)and external validation(AUC:0.594-0.617).Furthermore,the nomogram demonstrated good performance in calibration plot,Brier Score,and decision curve analysis.Subgroup analysis revealed robust predictive performance in patients with various clinical subtypes and mild to moderate PDH.Conclusions Preoperative PT and the percentage of monocytes were,for the first time,identified as predictive factors for PDH.The dynamic nomogram proved to be a valuable tool for predicting PDH after eTSS for PAs and demonstrated good generalizability.Patients could benefit from early identification of PDH and optimized treatment decisions.

Predictive value of pituitary tumor morphology on outcomes and complications in endoscopic transsphenoidal surgery

Purpose:Endoscopic transsphenoidal surgery(ETSS)is an increasingly utilized approach for resection of pituitary tumors.Prior studies have evaluated preoperative tumor size,location,and extent as prognostic factors for surgical resection.There is little data on the relationship between preoperative pituitary tumor radiographic morphology and surgical outcomes.Study Design:Retrospective longitudinal study.Setting:Single tertiary care institution.Subjects and Methods:Preoperative magnetic resonance imaging and computed tomography scans from patients undergoing ETSS for pituitary tumor resections from 2007 to 2017 were retrospectively evaluated.A neuroradiologist classified these pituitary tumors into six morphologic groups,each defined by volume,dimensions,extension,and shape.Surgical difficulty,rates of incomplete resection,and postoperative complications were then stratified in relation to the morphologic groups.Results:Pituitary tumors from 131 patients were classified from preoperative imaging into six characteristic morphologies:(1)microtumor,(2)round,(3)transverse oblong,(4)superior-inferior oblong,(5)bilobed,and(6)large lobulated.Tumors that were characterized with the large lobulated,bilobed,and transverse oblong morphologies correlated with higher rates of postoperative evidence of residual tumor(70%,36%,and 47%,respectively,all P<0.002).Likewise,large lobulated,bilobed,and transverse oblong morphologies were also associated with intraoperative cerebrospinal fluid leaks(70%,31%,and 35%,respectively,all P<0.05).Conclusions:We describe a novel descriptive system for the morphology of pituitary tumors that can be determined from preoperative imaging.Different tumor morphologic groups are associated with varying degrees of gross tumor resection,complications,and surgical difficulty.Utilizing pituitary tumor morphology may aid surgeons in planning the extent of resection,need for complex closure,and patient counseling.

Clinical features,radiological profiles,pathological features and surgical outcomes of pituicytomas:a report of 11 cases and a pooled analysis of individual patient data

Background:Pituicytoma is an extremely rare low-grade glial tumor that is closely related to the neurohypophysis axis.Most studies of pituicytomas include only several cases.To better understand this disease,we reviewed a series of cases of pituicytomas.The diagnosis and treatment of pituicytoma must be further elucidated.Methods:Eleven patients with pituicytoma admitted to Beijing Tiantan Hospital from 2012 to 2019 were selected.The clinical features,including radiological and histological examination,surgical records and prognosis were reviewed.Sixty-eight other previously published cases of pituicytoma also were used to analyze the predictive factors for the results.The Cox regression model was used for univariate and multivariate analyses.Results:Our patients included 5 males(45.5%)and 6 females(54.5%),with a mean age of 49.3 years.The tumor was located in the suprasellar region in 5 patients(45.5%),intrasellar region in 4 patients(36.4%),and intrasellarsuprasellar region in 2 patients(18.2%).All patients were misdiagnosed with other common tumors in the sellar region before the operation.During the operation,gross total resection(GTR)of the tumor was achieved in 6 patients(54.5%),and subtotal resection(STR)was achieved in 5 patients(45.5%).The mean progression-free survival(PFS)time was 29.82 months.Tumor progression after surgical resection occurred in 4 patients(36.4%).Among them,60.0%of the patients(cases 4,5,7)with STR experienced progression,while 16.7%of the patients(case 2)with GTR experienced progression.Combined with the 68 cases in the literature,GTR was an independent risk factor for PFS time(P<0.05).Conclusions:Pituicytomas are more common in middle-aged people and the sellar region.The clinical manifestations of pituicytomas are different,but no diagnostic clinical features have been identified other than an abnormally abundant blood supply.Currently,GTR is the best approach for the treatment of pituicytomas.More patients and longer follow-up periods were needed to further elucidate the biological features of pituicytomas.